NYC 9/11 Public Portal Document
PSC Analytical Services
0 Client Name ATC ASSOCIATES
Sample Receipt Checklist
Date and Time Receive 9/17/2002 1:00:00 PM
Work Order Numbe R02090971 Received by ADM
Checklist completed b I IQ?' Reviewed by _ t,'!
Signature / Date — — Initials I Dale
Matrix Carrier name Subbed direct to PSC-Bra
No.
Shipping container/cooler in good condition? Yes V Not Presen J
Custody seals intact on shippping container/cooler? Yes No -.: Not Presen I
Custody seals intact on sample bottles? Yes I 1 No I 1 Not Presen Li
Chain of custody present? Yes IV! No r
Chain of custody signed when relinquished and received? Yes v'I No IF
Chain of custody agrees with sample labels? Yes i . ; No ~!
Samples in proper container/bottle? Yes Y/, No L:
Sample containers intact? Yes 'V' No
Sufficient sample volume for indicated test? Yes 'Vi No Li
0 I
samples received within holding time?
Container/Temp Blank temperature in compliance?
Yes
Yes I
No LI
No CJ
Water - VOA vials have zero headspace? No VOA vials submitted 'i Yes ❑ No L_.;
Water. pH acceptable upon receipt? Yes No '~/!
Adjusted? Checked b
Any No and/or NA (not applicable) response must be detailed in the comments section b
Client contacted Date contacted: Person contacted
Contacted by: Regarding
Comments: `X C Cix. ,tL j ., ,, ii/
4e 4 '
Corrective Action
NYC-WTC 000130134
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